Prevention of Surgical Site Infections: A Systematic Review of Cost Analyses in the Use of Prophylactic Antibiotics

Abstract

Introduction: The preoperative phase is an important period in which to prevent surgical site infections (SSIs). Prophylactic antibiotic use helps to reduce SSI rates, leading to reductions in hospitalization time and cost. In clinical practice, besides effectiveness and safety, the selection of prophylactic antibiotic agents should also consider the evidence with regard to costs and microbiological results. This review assessed the current research related to the use of antibiotics for SSI prophylaxis from an economic perspective and the underlying epidemiology of microbiological findings.Methods: A literature search was carried out through PubMed and Embase databases from 1 January 2006 to 31 August 2017. The relevant studies which reported the use of prophylactic antibiotics, SSI rates, and costs were included for analysis. The causing pathogens for SSIs were categorized by sites of the surgery. The quality of reporting on each included study was assessed with the “Consensus on Health Economic Criteria” (CHEC).Results: We identified 20 eligible full-text studies that met our inclusion criteria, which were subsequently assessed, studies had in a reporting quality scored on the CHEC list averaging 13.03 (8–18.5). Of the included studies, 14 were trial-based studies, and the others were model-based studies. The SSI rates ranged from 0 to 71.1% with costs amounting to US$480-22,130. Twenty-four bacteria were identified as causative agents of SSIs. Gram negatives were the dominant causes of SSIs especially in general surgery, neurosurgery, cardiothoracic surgery, and obstetric cesarean sections.Conclusions: Varying results were reported in the studies reviewed. Yet, information from both trial-based and model-based costing studies could be considered in the clinical implementation of proper and efficient use of prophylactic antibiotics to prevent SSIs and antimicrobial resistance.

Magnitude, bacterial etiology profile and associated factors of surgical site infection in Ethiopia: Systematic review and meta-analysis

“…Among each individual isolated SSI was majorly caused by S. aureus and E. coli. This was in line with annual surveillance done in European countries and in other review [43,46].…”

<p>The Impacts of Deep Surgical Site Infections on Readmissions, Length of Stay, and Costs: A Matched Case–Control Study Conducted in an Academic Hospital in the Netherlands</p>

“…6 These infections incur costs, ranging between US$480 and US$22,130 per patient. 7 In addition, the European Centre for Disease Prevention and Control (ECDC) in 2011-2012 reported that SSI was the most common healthcare-associated infection with an incidence of 156.5 per 100,000 population. 8 Most concern exists about specific sites of infections, such as deep SSI (dSSI) involving infection of soft tissues of fascia and muscles with a high risk of development of sepsis as a complication.…”

<p>Optimizing compliance with surgical antimicrobial prophylaxis guidelines in patients undergoing gastrointestinal surgery at a referral teaching hospital in southern Iran: clinical and economic impact</p>

“…Similar findings have been reported by other studies. [15][16][17] During the intervention phase, patients received optimized antibiotic prescriptions, with a significant mean cost reduction of $591. A major reason for this cost reduction was a significant decrease in the duration of antibiotic use in the intervention group (94.19%) compared to the baseline group (7.87%; P<0.001).…”